Introduction: Data regarding cannabis effects on esophageal function are limited. Prior studies showed that cannabinoids decrease transient lower esophageal sphincter relaxations (TLESRs), suggesting that cannabis may interfere with inhibitory signals. Assessment of response to multiple rapid swallows (MRS) during high-resolution esophageal manometry (HRM) enables detection of impaired inhibition during MRS. In healthy subjects, deglutitive inhibition is seen during MRS, followed by a peristaltic contraction with higher vigor compared to single swallows. We hypothesize that cannabis impairs deglutitive inhibition during MRS and increases contractile vigor after MRS.
Methods: Retrospective review of cannabis users (N=36) and consecutive patients not on cannabis (N=47) who underwent HRM with MRS for evaluation of esophageal symptoms. Demographics, clinical information, and cannabis use (inhaled or ingested) were documented through a prospectively maintained motility database and chart review. Patients with prior gastroesophageal surgery, per-oral endoscopic myotomy, pneumatic dilation, esophageal botulinum toxin injection within 6 months of HRM, esophageal stricture, and current opioid use were excluded. Response to MRS was evaluated for intact versus impaired inhibition (defined as contractility with DCI >100mmHg-sec-cm during MRS) and presence of post MRS contraction augmentation (defined by a DCI post MRS greater than mean DCI for single swallows). Recent cannabis use was defined as less than 7 days from HRM. Categorical variables were analyzed by Fisher’s exact test.
Results: Overall, the rate of impaired inhibition during MRS was similar between cannabis users and control patients (22% vs 15%, P=0.56). However, in patients with recent cannabis use, impaired inhibition during MRS was significantly more frequent compared to control patients (41% vs 15%, P=0.03). The proportion of patients with augmentation post MRS was similar for cannabis users (overall and recent use) compared to patient controls (64% vs 74%, P=0.42).
Discussion: Compared with controls, patients with recent cannabis use were significantly more likely to present with impaired deglutitive inhibition during MRS. These findings support our hypothesis that cannabis interferes with inhibitory signals in the esophagus, which could manifest as achalasia, EGJOO, or DES. A larger sample size and additional studies are needed to confirm these findings and to elucidate the underlying mechanisms.
